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The impact of immunosuppression on postoperative graft function after graft-unrelated surgery: a retrospective controlled cohort study

BACKGROUND: Physicians are faced with a growing number of patients after renal transplantation undergoing graft-unrelated surgery. So far, little is known about the postoperative restitution of graft function and the risk factors for a poor outcome. METHODS: One hundred one kidney transplant recipie...

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Detalles Bibliográficos
Autores principales: Lederer, Ann-Kathrin, Haffa, Dominic, Felgendreff, Philipp, Makowiec, Frank, Fichtner-Feigl, Stefan, Huber, Roman, Kousoulas, Lampros
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521488/
https://www.ncbi.nlm.nih.gov/pubmed/31096947
http://dx.doi.org/10.1186/s12882-019-1358-2
Descripción
Sumario:BACKGROUND: Physicians are faced with a growing number of patients after renal transplantation undergoing graft-unrelated surgery. So far, little is known about the postoperative restitution of graft function and the risk factors for a poor outcome. METHODS: One hundred one kidney transplant recipients undergoing graft-unrelated surgery between 2005 and 2015 were reviewed retrospectively. A risk analysis was performed and differences in creatinine, GFR and immunosuppressive treatment were evaluated. Additional, a comparison with a case-matched non-transplanted control group were performed. RESULTS: Preoperative creatinine averaged 1.88 mg / dl [0.62–5.22 mg / dl] and increased to 2.49 mg / dl [0.69–8.30 mg / dl] postoperatively. Acute kidney failure occurred in 18 patients and 14 patients had a permanent renal failure. Significant risk factors for the development of postoperative renal dysfunction were female gender, a preoperative creatinine above 2.0 mg / dl as well as a GFR below 40 ml / min and emergency surgery. Patients with tacrolimus and mycophenolate mofetil treatment showed a significant lower risk of renal dysfunction than patients with other immunosuppressants postoperatively. Contrary to that, the risk of patients with cyclosporine treatment was significantly increased. Transplanted patients showed a significantly increased rate of postoperative renal dysfunction. CONCLUSIONS: The choice of immunosuppressant might have an impact on graft function and survival of kidney transplant recipients after graft-unrelated surgery. Further investigations are needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-019-1358-2) contains supplementary material, which is available to authorized users.